Biomedical subjects
A Sheiham
Publications and source records attributed to A Sheiham.
The common risk factor approach: a rational basis for promoting oral health.
Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio-political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.
Clinical decision-making in restorative dentistry. Content-analysis of diagnostic thinking processes and concurrent concepts used in an educational environment.
CONTEXT: Dental practice is affected by variation in diagnosis and treatment planning between clinicians. The process underlying the decisions leading to management of dental caries is poorly understood. OBJECTIVE: To explore diagnostic thinking and identify information used in the diagnosis, management and treatment of caries. SUBJECTS/MATERIALS: 15 senior dental students (mean age, 23.1 years; 66% female) in Mexico City were interviewed using a Simulated Patient Model (SPM). METHODS: The SPM consultation session and its review, aimed at eliciting an introspective recall description of the Diagnostic Thinking Processes (DTP) and the pieces of information (concepts) employed, were transcribed and content-analyzed (CA). CA reproducibility coefficients were 0.53 to 0.64. The cognitive psychology Gale & Marsden (GM) model was used to structure DTP and concepts. Data were analyzed with chi-squared tests. RESULTS: DTP utilization was similar to the original report in endocrinology and neurology cases. A wide variety of concepts were combined with DTP to describe the strategies and information preferentially resorted to while addressing four areas identified in the consultation. CONCLUSIONS: Narrow arrays of concepts of restorative concern (mostly physical features present in/on teeth) were often investigated using DTP 1, 2 and 4 in combination with the use of dental explorers. The heuristics detected link features common to the GM model and to an indirect pattern-recognition model, whereby reliance on visual/tactile concepts facilitates the acquisition of a clinically meaningful image. Non-clinical factors believed to be at play in the application of strategies were not investigated but were controlled for in the SPM.
How do routines of daily activities and flexibility of daily activities affect tooth-cleaning behavior?
OBJECTIVES: The aims of this study were: (1) to investigate the level of routines and flexibility of people's daily activity and to identify how tooth cleaning fits into these activities; and (2) to evaluate the impact of different levels of routines and flexibility in daily living on pattern (frequency of tooth cleaning), structure (range of items used in tooth cleaning), performance (relative effectiveness of tooth cleaning) and the outcome of performance (gingival bleeding on probing) in tooth cleaning. METHODS: A convenience sample of 471 Brazilians aged 24 to 44 years was selected from factories, offices, banks, shops, and hospitals. Behavioral, socioeconomic, and clinical data were collected through structured interviews. Dental plaque and gingival bleeding were assessed by clinical examination. Data were analyzed by means of logistic regression. RESULTS: A highly significant relationship was observed between routines of daily activities and tooth-cleaning pattern (OR = 2.3; 95% CI = 1.34, 3.92) after adjusting for age, sex, marital status, and socioeconomic status. No significant associations were observed between routines of daily activities and gingival bleeding. A significant association was observed between tooth-cleaning frequency (OR = 1.6; 95% CI = 1.07, 2.49), performance (OR = 2.7; 95% CI = 1.77, 4.14), outcome (OR = 2.3; 95% CI = 1.31, 3.18), and flexibility of daily activities. Those who had more flexibility of daily activities had lower gingival bleeding scores. CONCLUSION: People who have a less routinized and more flexible day have higher tooth-cleaning frequency than those who have a less flexible and more routinized day. In this study, those with a more flexible day also cleaned their teeth more effectively than those who had a less flexible day, and had reduced gingival bleeding.
Oral health and nutrition in older people.
The theoretical link between foods choice and masticatory efficiency has long been established. Recent evidence has confirmed this association, demonstrating a progressive alteration in food choice with decreasing numbers of teeth, with the greatest effect being among those who are edentulous. This altered food selection results in significant differences in the hematological status for some key nutrients in the one study in which this association was investigated. This paper summarizes some of the literature relevant to diet as a risk factor for systemic disease and identifies areas where altered food choice as a consequence of reduced masticatory efficiency might be placing individuals at increased risk of life-threatening conditions, such as atherosclerosis and cancer.
Preschool children's consumption of drinks: implications for dental health.
OBJECTIVE: To examine drinking patterns in pre-school children and their relationship to percentage of energy intake from non-milk extrinsic sugars. DESIGN: Secondary analysis of data from the national diet and nutrition survey (NDNS) relating to the dietary intakes of a representative sample of pre-school children in the UK. SUBJECTS: 1,675 children aged 1.5 to 4.5 years surveyed between July 1992 and June 1993. OUTCOME MEASURES: Proportion of consumers, average daily frequency of consumption and estimated seven day volume of consumption of different drinks. Percentage of average daily energy intake obtained from non-milk extrinsic sugars (NMES). RESULTS: Soft drinks were the most commonly consumed drinks followed by whole milk and diet or low sugar varieties of soft drinks. Half the sample were estimated to consume more than 1.5 litres of soft drinks and whole milk and over a litre of diet or low-sugar soft drinks per seven days. Fifty-six per cent of the children consumed soft drinks more than once a day. The youngest children (1.5-2.5 years) were more likely to consume whole milk and less likely to consume diet, soft drinks and skimmed milk than other age groups. Children from manual home backgrounds consumed more tea and coffee and were less likely to consume fruit juice than those from non-manual backgrounds. Drinks contributed 23% to total energy intake and 39% of NMES intake. Consumption of soft drinks, fruit juice and whole and semi-skimmed milk accounted for 59% of variance in percentage of energy from NMES. CONCLUSIONS: A large proportion of pre-school children consume considerable quantifies of soft drinks which have little or no nutritional value and are high in cariogenic non-milk extrinsic sugars. This has implications for children's dental and general health. Recommendations for drinks consumption should be included in food policy guidelines for pre-school children.
Inequalities in oral health: a review of the evidence and recommendations for action.
Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain. Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness. Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases.
The prevalence and impact of dental pain in 8-year-old school children in Harrow, England.
OBJECTIVE: To assess the prevalence, severity and impact of dental pain. DESIGN: Cross-sectional survey. SETTING: Schools in the London Borough of Harrow, England, in the summer term of 1995. SUBJECTS AND METHODS: The base population were all 2,300 8-year-old school children in Harrow. A cluster sampling of schools based on quotas from all postcode areas in Harrow was used. Data were collected through interviews with the children. MAIN OUTCOME MEASURES: Prevalence of previous toothache; prevalence of toothache in the previous 4 weeks; prevalence of toothache in the previous 4 weeks which resulted in a visit to the dentist, in stopping playing, eating, sleeping, going to school and taking painkillers. RESULTS: Of the 664 sample of children in the participating schools, 589 were interviewed (88.7%). The frequency of previous toothache was 47.5% (95% CI, 44-52) and dental pain caused crying in 17.7% (95% CI, 15-21) of children. 7.6% (95% CI, 5-11) of children had pain in the previous 4 weeks (45 children). Among these 45 children, this recent pain resulted in a visit to the dentist in 41.9% (19 children, i.e. 3.2% of all children), in stopping playing in 26.7% (12 children, i.e. 2.0% of all children), eating in 73.3% (33 children, i.e. 5.6% of all children), sleeping in 31.1% (14 children, i.e. 2.4% of all children) and in going to school in 11.1% (5 children, i.e. 0.8% of all children). CONCLUSION: Toothache in children is a sizeable problem in Harrow and had substantial consequences for children and their guardians. Freedom from disabling dental pain/discomfort is an outcome indicator of oral health and could be used as an explicit goal by dental systems. It is important to note however, that the present study did not assess the extent to which the dental pain was associated with avoidable dental problems as opposed to normal physiological processes. It is important that future work try and separate the prevalence of dental pain caused by physiological from avoidable pathological factors. In addition, future work is needed to assess how effectively and efficiently dental services are responding to people suffering with dental pain.
The relationship between tooth cleaning behaviour and flexibility of working time schedule.
This study tested whether there is a relationship between levels of flexibility of working time schedule and the pattern (frequency of tooth cleaning), structure (range of items used in tooth cleaning), and performance (relative effectiveness of tooth cleaning measured by levels of dental plaque) of tooth cleaning. 471 Brazilian workers from both sexes aged 24 to 44 years were selected from factories, offices, banks, shops and hospitals. Behavioural, socio-economic and clinical data were collected through structured interviews and clinical examination. Data analysis included frequency distribution and simple and multiple logistic regression. The response rate was 92.5%. Simple logistic regression showed there was a highly statistically significant relationship between flexibility of the working time schedule and tooth cleaning frequency, the range of oral hygiene aids used and the level of dental plaque. All 3 associations remained highly statistically significant after adjusting for age, sex, socio-economic status and marital status. Socio-economic status was statistically significantly associated with tooth cleaning frequency, the use of oral hygiene aids and the level of dental plaque. It was concluded that high flexibility of working time schedule is related to pattern, structure and performance of tooth cleaning.
The relationship between satisfaction with mouth and number, position and condition of teeth: studies in Brazilian adults.
The objective of this study was to analyse adults' subjective perception of satisfaction in relation to number, position and condition of natural teeth. Subjective perception of satisfaction was assessed by interview. Dental status was assessed. Two types of survey were carried out in Brazil: a longitudinal and a cross-sectional survey. The longitudinal study commenced in 1990, with 227 dentate people aged 45-54 years, of two social classes. Of the 227 subjects examined in 1990, 126 were re-examined and interviewed 3 years later. The cross-sectional survey used the same methods used for the longitudinal study. Six hundred and fifty-seven dentate males aged from 35 to 54 years were examined and interviewed. There was a positive correlation between satisfaction and position of teeth. Premolar pairs had a higher correlation with satisfaction in both studies. Anterior teeth were the most significant predictors of satisfaction. There was no difference in the percentage of satisfied persons between the baseline and follow-up studies. The results indicate that adults with three premolar pairs and intact anterior sextants were satisfied with their oral status. Keeping a certain number of teeth, depending on their position and condition, gave more satisfaction than having the missing teeth replaced with partial dentures.
The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain.
OBJECTIVES: To assess how the dental status of older people's mouths affected their stated ability to eat common foods. DESIGN: Cross sectional study. SUBJECTS: Survey was part of the oral health component of the nationwide British National Diet and Nutrition Survey: people aged 65 years and older. Two separate representative samples aged 65 and over: a free-living and an institutional sample. 881 free-living and 275 institution subjects had a dental exam and were interviewed about ability to eat key foods. RESULTS: Significant percentages of free-living people had difficulty or could not eat at least 4 of 16 foods, and about 1 in 5 dentate stated they had difficulty eating or could not eat raw carrots, apples, well-done steak or nuts. More of the edentate subjects stated that they had difficulty eating than the dentate. Perceived chewing ability increased with increasing numbers of natural teeth and pairs of opposing posterior teeth. Subjects reporting a sociodental impact were more likely to consider that they were unable to eat foods that required more chewing. Associations remained valid after correction for the effects of age, sex, social class and denture wearing status and region. Perceived dryness did not affect significantly the stated ease of eating most foods. There were more dietary restrictions reported by the institution sample. Some foods, such as nuts, apples and raw carrots could not be eaten easily by over half of edentate people in the institution sample. CONCLUSIONS: The stated selection of foods are substantially affected by numbers of teeth and occluding pairs of posterior teeth and presence of full dentures in significant percentages of older people.
The relationship between satisfaction with mouth and number and position of teeth.
A number of studies have suggested that many people are satisfied with less than 28 natural teeth. This review assesses the evidence. The main conclusion was that less than a complete dentition can satisfy oral functional needs. Missing posterior teeth were not very important from a subjective aspect. The demand for replacement of missing teeth is related to the position of missing teeth. Most studies agree that individuals were more concerned about missing anterior teeth and having anterior rather than posterior teeth replaced. Aesthetics is more important than function for a great majority of individuals. However, certain socio-demographic factors, such as age, can change the subjective need for replacement of missing teeth. Some studies have assessed the social and psychological impacts on oral health status. The position of missing teeth was assessed, in terms of groups of missing teeth, anterior or posterior, that would affect an individuals' subjective need for replacement by partial prosthesis. Large numbers of people that have free end removable partial dentures made do not wear them because subjective needs are lower than normatively determined needs for replacement of missing teeth. Some studies have proposed alternatives to the replacement of missing teeth, such as the shortened dental arch concept.
Criteria for restoration replacement and restoration life-span estimates in an educational environment.
The present survey assessed the subjective estimates of restoration longevity, the relative importance of the reasons to replace a restoration and the proportion of restorative treatment perceived to be carried out to replace previous restorations in a clinical setting where caries experience has been reported to be high. Three hundred and eight-four final-year dental students in Mexico City (64% female, mean age 23.2 years) made subjective longevity estimates (minimum acceptable, 'average' and ideal) for small and large amalgam restorations and cast restorations. Students attributed greater responsibility for restoration failure to patient-related factors than to dentist-related factors. The most important reasons given for the replacement of restorations were the presence of an active carious lesion and the presence of a lesion. The next most important reasons were the presence of fractured restorations, proximal overhangs or proximal marginal defects, and marginal defects. No marked differences could be detected in the restoration longevity appraisals compared either with other subjective estimations or to actual longevity figures, nor in the relative ranking of reasons to replace restorations between the estimates done by participants in this study and reports originating in low-caries settings.
Gingival ulceration in HIV infection. A case series and case control study.
All cases of HIV-associated gingival ulceration seen at a dedicated dental clinic in a 5-year period were reviewed and compared against other patients attending the clinic. 94 (7.1%) of 1308 patients had 146 episodes of gingival ulceration. 89 patients had 140 episodes similar to acute necrotising ulcerative gingivitis (ANUG) and responded well to conventional treatment for ANUG. The cases were compared with 269 controls in logistic regression. Gingival ulceration was associated with oral candidiasis, lower age and lack of AIDS diagnosis possibly due to a protective effect of co-trimoxazole medication. 5 patients with neutropenia had extensive ulceration without the microflora of ANUG. Histopathology, viral and bacterial culture revealed non-specific changes. The ulcers did not respond to the treatment regimen for ANUG but responded to treatment of their neutropenia. Gingival ulceration is not common in HIV infection. Most cases resemble severe ANUG. It is more frequent in younger people, those with oral candidiasis and without AIDS. Co-trimoxazole may be protective. A minority of cases with ulceration and associated neutropenia resembled the non-specific oral ulceration associated with HIV.
Can questionnaires replace clinical surveys to assess dental treatment needs of adults?
OBJECTIVE: The purpose of this study was to ascertain whether questionnaires can be used to replace clinical surveys by comparing normative and perceived caries status and treatment needs in a sample of adults living in East London, UK. METHODS: A cross-sectional study was conducted in two stages: a structured interview inquired about perceived dental caries status and treatment needs, and dental examinations were performed to determine oral health status and normative treatment needs. Perceived and normative assessments were compared for overall proportions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using the dental examination as a gold standard. RESULTS: Of 139 people examined, 122 were dentate. The PPVs for perceived caries and treatment need were 0.58 and 0.67, respectively. Overall agreement was 65.4 percent for the presence of caries and 64.7 percent for the presence of treatment need. However, no net error was found between the proportions of participants with decay, and a small net error (7.4%) was found between perceived and normative treatment need. CONCLUSIONS: Self-assessment is not useful to assess individual dental treatment need, but is of possible value in assessing the needs of adult communities.
Oral examination: a screening tool for HIV infection?
OBJECTIVE: To estimate the predictive values for HIV infection of diagnosis of oral manifestations of the infection. METHOD: Prevalence of oral manifestations was compared in cross sectional blinded clinical examinations of homosexual men attending a genitourinary medicine clinic. Data were extrapolated to populations in England and Wales based on estimates of the prevalence of HIV infection. RESULTS: Data were analysed for 572 HIV infected and non-infected men (312 and 260 respectively). Positive predictive values for erythematous candidiasis, hairy leucoplakia and pseudomembranous candidiasis were greater than 0.96 at the genitourinary medicine clinic and are estimated to be greater than 0.72 among homosexual men in London. CONCLUSIONS: Clinical diagnoses of mucosal lesions alone are poor predictors of HIV infection but are useful when used in conjunction with a social history to establish if there are risk factors for infection.
Burnout and issues of the work environment reported by general dental practitioners in the United Kingdom.
OBJECTIVE: To investigate causes of burnout among general dental practitioners. DESIGN: A cross-sectional investigation. SETTING: General dental practices in two areas of the UK and a group of continuing education sessions. SUBJECTS: 325 general dental practitioners, composed of two random samples recruited from two areas of the United Kingdom and an opportunistic sample, recruited from continuing education sessions. OUTCOME MEASURES: Levels of burnout, as measured by scores on one of the three burnout sub-scales--emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Respondents were more likely to report high levels of emotional exhaustion and low levels of personal accomplishment if they worked in practices with few other dentists. Those respondents reporting high levels of depersonalisation were more likely to provide a greater proportion of care through the National Health Service. CONCLUSIONS: Burnout in this sample of general dental practitioners was related to features of their work organisation structure rather than necessarily due to an involvement with patients or the respondents' personal characteristics. Levels of social support in the workplace, measured here by the number of dentists in a practice, appear to have a protective effect against some aspects of burnout.